Problems With Open Payments Program Abound

Maya (2)Guest Post from Maya A. Babu, MD
Neurosurgical Resident, Mayo Clinic
Rochester, MN

Representing the American Medical Association (and neurosurgery) I participated in an important panel session on the Sunshine Act (specifically on the Open Payments Database) during the 15th Annual Pharmaceutical Regulatory and Compliance Congress and Best Practices Forum sponsored by the Pharmaceutical Compliance Forum in Washington, DC. The target audience was those who worked in pharmaceutical compliance. Crucial concepts discussed included:

  • The current state of the data
  • The challenges faced in corporate compliance with the regulations
  • The problems with the reporting system as presently configured
  • The potential impact on organizations within medicine

Doug Brown, Director of the Data Sharing and Partnership Group of the Centers for Medicare & Medicaid Services (CMS), spoke about the published and missing data. Key information given included:

  • 2.7 million identified records published along with 1.7 million de-identified records
  • 199,000 remain unpublished
  • $3.5 billion in value published
  • $1.1 billion remains unpublished (NB: Just 199,000 records involve $1.1 billion in value A rather disturbing figure)
  • 9000 records are in dispute
  • 190,000 have been marked for delayed publishing, due to granting requirements, patent applications, or other restrictions.

He also spoke of the “context” feature on the website which he feels has not been appropriately utilized. This portion of the website provides scant explanation for what the transfers of values included, such as research versus education versus meals.

Other panelists were Charles Ornstein, a reporter with ProPublica, John Murphy of PhRMA, Maggie Feltz of Purdue Pharmaceuticals, and Cindy Bongiovanni of Bristol Meyers Squibb. These panelists noted critical information deficiencies including the inaccuracy of the attributions in the database. For instance, pharmaceutical payments listed as device payments, and vice versa. The pharmaceutical compliance officers decried the challenges of accurate reporting in terms of recording transfers of value and transmitting this information to CMS. The industry voiced additional concerns about how tedious it was to track transfers of value for “nominal” amounts (the standard for reporting is any item greater than $10) and the amount of manpower, time, and record-keeping required to accurately track the volume of this information.

Neurosurgery supports and welcomes transparent physician-industry interactions to foster healthy relations and spur innovative device development to benefit patients. Within the relatively small specialty of neurosurgery, there are numerous examples of just such benefit such as the growth of effective Deep Brain Stimulation, and the resulting benefits this technology has provided countless patients.

However, neurosurgery has serious ongoing concerns about the Open Payments Database, including:

  • Accuracy of the attributions for transfer of value (whether it was for meals, or education, or research) as well as the amount of the value transfer cited
  • Transparency in terms of the stated context for the transfer of value (i.e. research grants are appropriately explained and not confused with “salary”).
  • The chilling effect on education with medical textbooks and journal reprints included for reporting under the Sunshine Act. This particularly impacts neurosurgeons in underserved or rural communities without a close affiliation to an academic center.

Finally, for all of organized medicine, there is a new dilemma posed by transparency websites including Open Payments. What will be the impact of failure to disclose this data in other components of our professional activities and how can or should this be monitored? While questions such as these may seem outlandish, as more information is publicly released by the administration, and more news outlets delve into the numbers, it is important for all to consider all the implications of disclosure, transparency, and context.

Posted in Guest Post, Health, Medical Innovation, Medicare | Tagged , , , , |

AANS and CNS Release 2015 Legislative Agenda

1236756_10201843651315115_1054821300_nToday, the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) released its 2015 legislative agenda, which includes action items such as abolishing the Independent Payment Advisory Board (IPAB), expanding support for graduate medical education, championing an improved Medicare reimbursement system, and alleviating the medical liability crisis. A few of our top priorities are detailed below and readers can view the full legislative agenda by clicking here.

  • ABOLISH THE INDEPENDENT PAYMENT ADVISORY BOARD (IPAB). Established by the Affordable Care Act (ACA), the IPAB is a 15-member government board whose members are appointed by the president. The principal responsibility of this board is to cut Medicare spending. Proposed spending cuts automatically go into effect if Congress does not replace the recommendations with cuts of equal magnitude. Congress only has a very short time in which to pass its own proposal—making it a virtual certainty that the board’s recommendations would be adopted. The AANS and CNS strongly urge repeal of the IPAB because leaving Medicare payment decisions in the hands of an unelected, unaccountable governmental body with minimal congressional oversight will negatively affect timely access to quality neurosurgical care for our nation’s senior citizens and those with disabilities.
  • EXPAND SUPPORT FOR QUALITY RESIDENT TRAINING & EDUCATION. An appropriate supply of well-educated and trained physicians—both in specialty and primary care—is essential to ensure access to quality healthcare services for all Americans. Unfortunately, the nation is facing a serious shortage of physicians, due to an aging population and the expansion of health insurance coverage through the ACA. And while medical schools in the U.S. have increased their enrollments, and additional medical and osteopathic schools have been established, the number of Medicare funded resident positions has been capped by law at 1996 levels. To ensure an adequate supply of physicians, Congress should (1) eliminate the current graduate medical education (GME) funding caps and increase the number of funded residency positions; (2) expand funding to fully cover the entire length of training required for initial board certification; channel a larger percentage of GME funds directly to the academic departments responsible for resident education; (3) allow resident and fellows to bill for the services they render after achieving verified competence in particular skills; (4) provide the profession with the tools, including antitrust relief, to ensure a well-trained physician workforce; (5) maintain current financial support for children’s hospital GME; (6) encourage all other payers to contribute to GME programs; and (7) ensure that the Accreditation Council for Graduate Medical Education (ACGME), American Board of Medical Specialties (ABMS) and Association of American Medical Colleges (AAMC) retain their preeminent roles in overseeing resident training and education.
  • CHAMPION AN IMPROVED MEDICARE PHYSICIAN PAYMENT SYSTEM. Year after year, because of Medicare’s flawed sustainable growth rate (SGR) formula, physicians face significant cuts in Medicare reimbursement. And time and time again, Congress intervenes with a short-term “fix” to prevent these steep cuts. Congress needs avoid band-aid solutions for fixing the physician payment system and once and for all replace the Medicare SGR formula with a stable mechanism for reimbursing physicians. Any new payment system must also allow patients and physicians to privately contract without penalty to either patient or physician, and must maintain a viable fee-for-service option in Medicare. Preserving this option for Medicare beneficiaries is especially critical for those patients seeking specialty care—particularly neurosurgical services. Finally, to ensure access to vital surgical services, Congress must rescind the Centers for Medicare & Medicaid Services’ (CMS) plan to eliminate the 10- and 90-day global surgery payment package.
Posted in Access to Care, Coding and Reimbursement, Congress, Emergency Care, GME, Health, HIT, IPAB, Medical Innovation, Medical Liability, Medical Research, Medicare, Patient Safety, Quality Improvement, SGR, Workforce Shortage | Tagged , , , , , , , , , |

Neurosurgeons: Elevating the Quality of Care for our Smallest Patients – Hydrocephalus Guidelines Published

FlanneryAnnGuest post from Ann Marie Flannery, MD, FAANS, FACS
Pediatric Neurosurgeon
Childrens Multi Specialty Clinic
Womens and Childrens Hospital
Lafayette, LA

Hydrocephalus is one of the most common birth defects, impacting one out of every 500 births in the U.S. Fortunately, neurosurgeons can effectively treat this problem. In an effort to assure the highest quality of care to the smallest of neurosurgical patients, evidence based guidelines for the care of infants and children with hydrocephalus have been developed and published in a special supplement to the Journal of Neurosurgery: Pediatrics. These guidelines were created by a task force led by pediatric neurosurgeons with critical input also solicited from neonatologists and patient’s families.

This series of articles are an essential resource not only for pediatric neurosurgeons but also anyone who takes care of children with this common and complex disorder. Pediatricians, neonatologists, infectious disease specialists, and pediatric surgeons will all find something of value in this document.flannery-hydro-cover (2)

Consider the following facts about hydrocephalus:

  • Hydrocephalus is the leading pediatric neurosurgical diagnosis affecting up to one in 500 infants and children
  • An additional 6,000 children annually develop hydrocephalus by age two
  • Effective treatment of hydrocephalus can result in significant improvement in neurological function
  • While the surgical treatment of hydrocephalus is often thought of as being simple, the complications and long-term implications of the diagnosis and treatment can be difficult
  • Re-admission after VP shunt surgery is common

For all these reasons, evidence based improvement in care is especially important.

These guidelines are ambitious, covering the wide spectrum of causes, interventions, and complications associated with hydrocephalus. The evidence presented in these guidelines was culled from almost 2000 abstracts. Diverse topics covered include:

  • Treatment of post hemorrhagic hydrocephalus in premature infants
  • Evidence for the use of preoperative antibiotics
  • Use of antibiotic impregnated catheters
  • Effectiveness of technology such as computer-assisted navigation, ventricular ultrasound and ventricular endoscopy
  • Evidence for selection of shunt valves
  • Effectiveness of a third ventriculostomy when compared to a shunt
  • The usefulness of using ventricular size as a judgment for treatment effectiveness

As with any evidence based guidelines, the quality of evidence strongly influences the quality of the recommendation. The pediatric neurosurgeons continue to elevate the quality of care delivery through development of this set of guidelines. In addition, pediatric neurosurgery is committed to ongoing improvement in quality of care and plan to direct their next efforts toward management of plagiocephaly, the acquired skull shape problem frequently seen in the era of “back to sleep.”

Posted in Emergency Care, Guest Post, Health, Patient Safety, Quality Improvement | Tagged , , , , , , , |